- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $902.57 / $2,747.00 / $5,454.00
| Facility | | $902.57 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $820.77 / $979.06 / $1,307.23
| Professional | | $820.77 | $979.06 | $1,307.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,591.00 / $3,728.00 / $13,773.00
| Facility | | $1,591.00 | $3,728.00 | $13,773.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.29 / $1,939.09 / $7,375.48
| Professional | | $977.29 | $1,939.09 | $7,375.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,828.41 / $1,965.84 / $3,212.69
| Professional | | $1,828.41 | $1,965.84 | $3,212.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $956.00 / $1,051.59 / $6,493.89
| Facility | | $956.00 | $1,051.59 | $6,493.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $713.28 / $1,572.39 / $3,115.96
| Professional | | $713.28 | $1,572.39 | $3,115.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $814.00 / $1,909.00 / $6,679.00
| Facility | | $814.00 | $1,909.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,142.28 / $1,470.85 / $2,207.80
| Professional | | $1,142.28 | $1,470.85 | $2,207.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,223.07 / $2,414.34 / $3,104.89
| Professional | | $1,223.07 | $2,414.34 | $3,104.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,516.53 / $1,516.53 / $1,516.53
| Professional | | $1,516.53 | $1,516.53 | $1,516.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,591.00 / $4,751.20 / $16,547.20
| Facility | | $1,591.00 | $4,751.20 | $16,547.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,070.13 / $1,941.91 / $7,375.48
| Professional | | $1,070.13 | $1,941.91 | $7,375.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,591.00 / $4,006.00 / $10,764.00
| Facility | | $1,591.00 | $4,006.00 | $10,764.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $987.36 / $1,525.33 / $3,218.38
| Professional | | $987.36 | $1,525.33 | $3,218.38 |